Conduction system pacing versus biventricular pacing in heart failure with reduced ejection fraction: A systematic...

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Conduction system pacing (CSP) is an emerging alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT).
• Patients with heart failure with reduced ejection fraction (HFrEF) and ventricular dyssynchrony are candidates for CRT, but CSP's comparative efficacy remains under investigation.

Purpose of the Study:

• To evaluate and compare the clinical outcomes of CSP versus BVP for cardiac resynchronization in patients diagnosed with HFrEF.
• To synthesize evidence from randomized controlled trials (RCTs) to determine the relative benefits and drawbacks of each pacing strategy.

Main Methods:

• A systematic review and meta-analysis of RCTs comparing CSP and BVP for CRT in HFrEF patients.
• Searches were conducted across PubMed, Scopus, and Cochrane databases.
• Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.

Main Results:

• CSP demonstrated a significantly greater reduction in QRS duration (MD -13.34 ms) and improved New York Heart Association (NYHA) functional class (SMD -0.37) compared to BVP.
• Left ventricular ejection fraction (LVEF) significantly increased with CSP (MD 2.06%).
• No significant differences were observed in left ventricular end-systolic volume, lead capture threshold, or procedure time.

Conclusions:

• Conduction system pacing may offer superior electrocardiographic, echocardiographic, and symptomatic benefits compared to biventricular pacing for HFrEF patients requiring cardiac resynchronization.
• CSP represents a potentially more effective CRT strategy, warranting further investigation and consideration in clinical practice.